Superior capsule reconstruction with long biceps plus infraspinatus partial repair vs isolated biceps tenotomy in massive, irreparable rotator cuff tears - 29/04/26

Doi : 10.1016/j.otsr.2026.104730

Hugo Barret ^a,^b,^c,⁎ , Emilie Mathieu ^a, Vincent Martinel ^d, Patrice Wong ^a,^c, Quentin Rialet ^a,^c, Pierre Mansat ^a,^b,^c, Nicolas Bonnevialle ^a,^b,^c

^a Département d'Orthopédie Traumatologie du CHU de Toulouse, Toulouse, France

^b Institut de Recherche Riquet (I2R), Toulouse, France

^c Clinique Universitaire du Sport, Toulouse, France

^d Polyclinique de l'Ormeau, Groupe Elsan, Tarbes, France

^⁎ Corresponding author at: Hôpital Pierre Paul Riquet, CHU de Toulouse, Place Baylac, 31059 Toulouse Cedex 09, France. Hôpital Pierre Paul Riquet CHU de Toulouse Place Baylac Toulouse Cedex 09 31059 France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 29 April 2026

Abstract

Aims

The surgical management of massive, irreparable rotator cuff tears remains controversial. The aim was to evaluate the short-term clinical and radiological outcomes of Superior Capsule Reconstruction (SCR) with Long Biceps Plus Partial Repair versus isolated tenotomy (ToLB) of the long head of biceps tendon.

Methods

This was a single-center continuous study of patients with irreparable posterosuperior cuff tears, who underwent SCR (posterior transposition of the long biceps and partial repair of the infraspinatus) or ToLB, and had a minimum follow-up of 2 years. Clinical outcomes were Constant score active range of motion, VAS for pain and Subjective Shoulder Value (SSV). Acromiohumeral distance was measured on A/P radiographs before surgery and at the last follow-up visit.

Results

Thirty-seven patients (mean age 66 ± 9 years) were included: 19 SCRLB (Superior Capsule Reconstruction with Long Biceps), 18 ToLB. The two groups were comparable in terms of age and type of cuff tears. At a mean follow-up of 28 ± 12 months, the SCRLB group had better shoulder Constant score than the ToLB group: 71 ± 21 points vs. 57 ± 14 points (p = 0.001). Mobilities was better in SCRLB group than the ToLB group: anterior elevation 157 ± 15° vs. 137 ± 28° (p = 0.012), external rotation 51 ± 14° vs. 41 ± 15° (p = 0.04), internal rotation 9 ± 1.5 points vs. 8 ± 2 points (p = 0.034). Pain on VAS was 0.7 ± 1.3 points vs. 3.9 ± 2.3 points (p < 0.001) and SSV score was 86 ± 11% vs. 63 ± 17% (p < 0.001) in the SCRLB and ToLB groups, respectively. No revisions were needed in the SCRLB group. In the ToLB group, 5 patients required reverse shoulder arthroplasty. The acromiohumeral distance was stable overtime in the SCRLB group (10 ± 1.6 vs. 9.8 ± 2 mm, p = 0.2), decreased in the ToLB group (9.8 ± 2 vs. 7.4 ± 2.4 mm, p = 0.003).

Conclusion

At 2 years of follow-up in this series, SCR with the long head of the biceps combined with partial repair of the rotator cuff seems to give better clinical and radiological results than isolated tenotomy. Comparative studies with larger numbers of patients per group are needed to confirm these results.

Level of evidence

III; therapeutic, retrospective cohort study.

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Keywords : Rotator cuff tears and arthroscopic repair, Massive rotator cuff tears, Massive irreparable rotator cuff, Biceps tenotomy or tenodesis, Superior capsular reconstruction, Hamada classification